Digital exclusion as a potential cause of inequalities in access to care: a survey in people with inflammatory rheumatic diseases

Objectives: COVID-19 led to rapid uptake of digital healthcare. We sought to examine digital access, health and digital literacy, and impact on confidence and satisfaction with remote consultations in people with inflammatory rheumatic diseases (IRDs). Methods: People with IRDs (n=2,024) were identified from their electronic health record and invited to participate in a cross-sectional survey, using short message service (SMS) and postal approaches. Data were collected on demographics, selfreported diagnosis, access to and use of internet-enabled devices, health and digital literacy, together with confidence and satisfaction with remote consultations. Ethical approval was obtained (Ref 21/PR/0867). Results: Six hundred and thirty nine (639) people completed the survey (mean (sd) age 64.5 (13.1) years, 384 (60.1%) female). 287 (44.9%) completed it online. One hundred and twenty-six (19.7%) people reported not having access to an internetenabled device. Ninety-three (14.6%) reported never accessing the internet; this proportion was highest (23%) in people with rheumatoid arthritis (RA). One hundred and seventeen (18%) reported limited health literacy. Even in those reporting internet use, digital literacy was only moderate. People with limited health or digital literacy or without internet access were less likely to report confidence or satisfaction with remote consultations. Conclusion: Limited health and digital literacy, lack of digital access and low reported internet use were common, especially in older people with RA. People with limited health literacy or limited digital access reported lower confidence and satisfaction with remote consultations. Digital implementation roll-out needs to take account of people requiring extra support to enable them to access care digitally or risks exacerbating health inequalities